AmMed Direct: Online Application Form

AmMed Direct LLC requires a drug screening test as a part of its selection and hiring process.
I understand that AmMed Direct, LLC has a commitment to maintain an alcohol/drug-free workplace and that AmMed Direct LLC requires a drug screening test as a part of its selection and hiring process. I understand that such drug screening will consist of the testing of a urine sample or other medically recognized test designed to detect traceable amounts of a controlled substance in my body. If it is determined my specimen contains a controlled substance or was altered or substituted, I will be disqualified from consideration for employment and any offer of employment will be withdrawn. I further understand and agree that if I am employed, I may be required to submit to alcohol/drug-testing under certain circumstances during my employment.

I have read, understand and agree to the above statements.

YesNo

AmMed Direct LLC is committed to helping persons with diabetes.
By applying for employment with AmMed Direct, you are attesting and affirming that you are committed to helping our customers with diabetes. AmMed Direct will provide diabetes and job-specific training to empower you with the knowledge and tools required to effectively assist and resolve prospective and current customer concerns or questions.

I have read, understand and agree to the above statements.

Job Applying For:
First Name (required):	Middle Name:	Last Name (required):
Email Address (required):
Street Address:
City:	State:	Zip:
Home Phone Number:	Alternate Phone Number:	Best Hours to Contact Me:
Have you ever filed an application with us before? YesNo Have you ever been employed with us before? YesNo Do you have any relatives that currently work for AmMed Direct? YesNo Are you under 18 years of age? YesNo If you are under 18 years of age, can you provide required proof of your eligibility to work? YesNo If hired, can you submit documentation verifying your identity and your legal right to work in the U.S.? YesNo Are you currently employed? YesNo May we contact your present or most recent employer? YesNo Are you currently on "lay-off" status and subject to recall? YesNo Are you available to work: Full Time YesNo Are you available to work: Part Time YesNo Are you available to work: Shift work YesNo Are you available to work: Temporary YesNo Are you willing and available to work any shift? YesNo If no, what is your preferred shift? Are you able to work overtime? YesNo On what date would you be available to work?

Current or Most Recent Position Company: Address: Position Title: Responsibilities: Salary: Employment Start Date: Employment End Date: Supervisor Name: Supervisor Phone: Reason for Leaving:

Previous Position Company: Address: Position Title: Responsibilities: Salary: Employment Start Date: Employment End Date: Supervisor Name: Supervisor Phone: Reason for Leaving:

List any skills that you bring to the position:

High School   School Name and Location: Received Diploma?   YesNo Describe Course of Study:     Undergraduate University School Name and Location: Received Diploma?   YesNo Describe Course of Study:	Graduate University School Name and Location: Received Diploma? YesNo Describe Course of Study:   Special Training

Have you ever had any job-related training in the military? YesNo
If yes, please describe:
Branch of Service:	Years of Service:	Rank:

Have you ever been convicted of a felony or a misdemeanor that has resulted in incarceration, probation or fine? YesNo
If yes, please list date of conviction:
Please explain:

Check the box in front of the skill that applies to you: Inbound Customer Service Calls Microsoft Excel Inside Sales Outbound Customer Service Calls Microsoft Access Outside Sales Data Entry Microsoft Outlook Palletjack 10 key Microsoft Word Pallet Stacker Filing Microsoft Powerpoint Order Picking Faxing Internet Order Packing Mail Room Inbound Sales Calls Shipping/Receiving Multi-line telephone Outbound Sales Calls         Do you speak any other languages? If yes, please list:

Consent to Release Information and Background Check

I hereby give AmMed Direct, LLC the right to make a thorough investigation of my past employment, education and activities. I release all persons, institutions, companies, and corporations supplying such information from any liability. I release AmMed Direct, LLC from any liability which might result from making such an investigation. I understand that any false answers or statements or implications made by me in this application or other required documents shall be sufficient cause for denial of employment or discharge. Additionally, I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between AmMed Direct and myself for either employment or for the providing of any benefits. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding. I understand that I have the right to terminate my employment at any time and that AmMed Direct, LLC retains a similar right. I understand that if employed, I will be required to abide by all company policies, standards and regulations.

I have read, understand and agree to the above statements.

YesNo

Accommodation for Individuals with Disabilities

AmMed Direct, LLC offers reasonable accommodation in the employment process for individuals with disabilities. If you need assistance in the application or hiring process to accommodate a disability, you may request an accommodation at any time. Please contact Human Resources at AmMed Direct by phone at (615) 941-3500 or by mail 5720 Crossings Blvd. Antioch, TN 37013.

I have read, understand and agree to the above statements.

Voluntary Disclosure

Please indicate how you learned about AmMed Direct. This helps us on tracking and also future recruiting.

How did you learn about AmMed Direct?	Please Select Walk In Employment Agency Careerbuilder Government Service Agency Advertisement School Placement Office I worked for AmMed before Employee Referral Career Fair Other Source
Please enter the name of the employee.
Please explain.

Affirmative Action Survey

Governmental agencies require periodic reporting on the sex, ethnicity, disability status, and veteran status of applicants. This data is used for affirmative action analysis and review only. This data is for periodic governmental reporting and will be kept in a Confidential File separate from the Application for Employment. Please know that the submission of this information is voluntary. We thank you and appreciate your time, and cooperation.

Gender	MaleFemale
Race/Ethnic Group	Please Select Caucasian African-American Hispanic Native American/Alaskan Native Asian/Pacific Islander Other
Please define.

 

Post Your Resume

So that we can get a better understanding of your background/skills please upload your resume.

 

By typing your name in the space provided below, this serves as your digital signature which affirms the information you provided is correct.

Signature of Applicant (Please type your full name):

Applicants are considered for current open positions and employees are treated during employment without regard to race, color, religion, sex, national origin, marital status, veteran status, medical condition, or disability. As an employer/government contractor, we comply with government regulations and affirmative action responsibilities. AmMed Direct, LLC is an Equal Opportunity Employer. AmMed Direct is a participant of E-Verify.

In effort to support better health and Better Care for our employees, visitors and the community, AmMed Direct's campus is tobacco free. Thank you for supporting our goal of better health.